A 22-year-old man with one-year history of progressive dysarthria, dysphagia, drooling,
ataxic gait, and disinhibition. He reported history of acute hepatitis five months
ago. Neurological examination revealed bilateral upper limb action tremor, parkinsonism,
hyperreflexia, and clonus. Low serum ceruloplasmin levels (7.6 mg/dL, Normal: 20-40
mg/dL) and Kayser-Fleischer rings in the cornea were detected. Brain MRI showed abnormal
bilateral hyperintensities ([Figure 1]) and panda with “bright eyes” ([Figure 2]).
Figure 1 Axial FLAIR image demonstrates hyperintensities with central dark signal intensity
in the putamen and caudate nuclei, and hyperintensities in thalami.
Figure 2 The red nuclei appear bright in axial T2-weighted image with the appearance of panda
with “bright eyes”.
Panda with “bright eyes” is a rare variant of the neuroimaging sign called “face of
the giant panda”, associated with Wilson disease[1],[2]. It is probably related to paramagnetic effects of cooper and iron accumulation
in the red nuclei.
